In osteopathy the main aim is to find and release the “primary lesion” within an organism. This primary lesion is determined by the practitioner using a series of diagnostic tools with the aim of getting as specific as possible. Some of these diagnostic methods are: arcing, local listening, general listening and Manual Thermal Diagnosis followed by mobility and motility tests in the local structures. Once the primary lesion is found by the practitioner it will be treated manually to resolve the “chain of lesions” found.

Historically (Still and Sutherland), the osteopathic concept began by observing that:

Structure has an effect on structure. A tibio-talar joint in lesion will have an effect on the sacroiliac joint, which will affect the dorsal vertebrae, the atlanto-occipital balance and the cranial sutures.

Then Jean Pierre Barral D.O. and others started to inquire deeper into the following relations:

Structure has an effect on viscera and vice versa. A liver in a motion restriction will result in a lesion of the vertebral spine (T8/9) and then have its effect on other structures as described above; and a fixated T8/9 may create a lesion in the liver.

Viscera have an effect on emotion and vice versa. Unexpressed anger may “download” into the liver as congestion, leading to a motion restriction of the liver, leading to a fixation of the spine. Or a motion restriction of the liver (i.e., after hepatitis) may lead to a lack of energy and a choleric behavior.

Peripheral nerves and cranial nerves have an effect on the autonomic nervous system, the organs and structure itself. Compression of the lumbar plexus may result in tension and lesions in the knee joint, which leads to a motion restriction of the kidney and then affects the other systems.

Arteries and veins are affected by any tension/lesion in the body. Therefore any tension or lesion may influence the trophism of all tissues.

This list of structural, physiological and “electrical” relationships, while not complete, nevertheless clearly shows the specificity and distinctions that osteopathy has taken since its beginning. As a system it is relating to the body/soma itself.

Now let me highlight the template that we as structural integrators work from. The main and essential difference is that we take gravity – an external factor – into our consideration. We manipulate soft tissues to integrate a human structure into a greater field, the gravitational field. Dr. Rolf used a “myofascial” terminology to verbalize her/our system. Myofascial freedom and organization allow for better integration into the context of the gravitational field. The original Ten Series was designed to systematically restructure the human body to align better with gravity.

Dr. Rolf, after she disengaged from the osteopathic students in the 1960s, engaged with the zeitgeist of the “human potential movement”. She lived and taught in the context of the Esalen Institute, the Gestalt therapy founded by Fritz Perls, and searched for an answer to what it takes to help the evolution of individual organisms to be better supported by gravity and to interact more easily and more expressively with the environment. In my understanding, she believed that there is a balance from within the body affecting the world outside, and the world outside reflects into our organism and structure.

In the meantime – almost thirty years after her death – our understanding of the pioneering work she and the osteopaths have done has matured:

Figure 1 illustrates the tonic function concept, where there are four domains of structure that influence each other to regulate tonic function. “Pre-movement” and our gravity organization rule human expression and behavior. In structural integration/Rolfing we choose to enter this system via the Physical Structure, aiming for perceivable results in that area as well as looking for results from our input in the other three structures, which determine the interrelationship with the outside world. All this said, for me the daily practical question when I have clients walking into my office stays the same: How can I interact with another intelligent system in the most efficient way?

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First: it is clear that if we interact with the Physical Structure domain (which I do in my practice), we cannot reduce this to its myofascial anatomy alone. In examining the myofascial layers containing the trunk, you see in Figure 2 that the viscera with their supporting connective tissue structures take up more than 80% of the space.

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Figure 2: Tranverse cut at the level of T10, showing the myofascial frame versus the visceral content. From Peter Schwind’s book Fascia and Membrane Technique (2006); reprinted with permission from the author and Elsevian Urban & Fischer, Germany.

In our Rolfing “recipe”, we spend the 1st, 3rd, 5th and 7th sessions differentiating the myofacial layers surrounding the thoracic content, and if we include the 2nd, 4th and 6th sessions we also differentiate the posterior myofascial components of the spine.

Myofascia, as we know, is made up of collagen, elastin fibers and ground substance, therefore it has elastic and plastic properties. If you take the membranes lining and supporting the thoracic cavity, there are less elastic fibers and the mobility of the layers in relationship to each other is maintained by the serous fluids in between the layers. Any lack of fluidity will have an effect on the resilience of the mobility and also on the musculoskeletal frame.

Second: If we improve our technical manual skills to include the membranous components of the “content”, our effectiveness in the Physical Structure will heighten the “interoception” of our client and affect tonic function and the other structures mentioned, possibly leading to a changed “exteroception” that creates better proprioception and therefore changes not only physiological function but also expressive behavior.

Imagine if we improved our concept and skills to include the viscera (and other somatic systems) to do an inclusive Ten Series. Let’s say that we keep the first three sessions as a preparation mainly of the myofascial planes.

In the third hour we structurally aim to differentiate:

• the thorax from the shoulder girdle and the arm
• the pelvis from the lumbar spine (abdominal cavity)
• the pelvis from femur/ leg itself.
• The pelvis from the 12th rib

Functionally we relate:

• front to back depth
• the shoulder and pelvic girdle in contralateral movement

In this hour we start to enter the “inner lining” of the cavities; the renal fascia and the pleura approximate closely to the 12th rib.

In the fourth hour our intervention would include the “bindegewebslager” – the connective tissue and fat tissue surrounding and supporting the bladder, uterus/prostate and the rectum. In addition, we would consider all other abdominal structures that “hang” from the lumbar spine such as the mesenteric roots, Toldt’s membrane, and the suspensory ligament of the duodenal-juojenal junction (Muscle of Treitz); see Figure 3.

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In the fifth hour, our interventions could include the pleura and the pleural dome, the mediastinum, and all visceral (peritoneal) attachments of the diaphragm from below: the coronary ligament, left/right triangular hepatic ligaments, the phrenico-gastric ligament, etc.

In the sixth hour our additional focus could become the sciatic nerve with the sacral plexus or the median nerve and the brachial plexus (see Figure 4), just to name two options.

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The seventh hour could include specifically the visceral compartments of the neck, larynx and pharynx, and the tensions inside the cranial cavity as given by the cranial and spinal dura mater.

The above mentioned connections are meant to be a possible outlook into an inclusive recipe, not a checklist to be accomplished in these sessions. The precision we can learn from the osteopathic world can make our work more efficient and lasting.

Relating these “visceral inner bridges” into the “inner shapes” as they relate to the Physical Structure (see Peter Schwind’s book Fascial and Membrane Technique) is one of the avenues for continued exploration.

To follow the path of changes that show up via tonic function on the levels of meaning, perception and coordination – and by this I mean to enhance the life quality and expressive freedom of each client in gravity – is the advantage we inherited from Dr. Rolf.

Our challenge will be to learn how to maintain the integrity of our own system of structural integration and its values without neglecting developments in the field of manual medicine. To retreat into myofascial orthodoxy is a lazy escape. I image that Dr. Rolf herself would have developed the work. Now it is up to us to continue down that path.

Christoph Sommer is a Certified Advanced RolferTM and a member of the European Rolfing faculty and the Barral Institute faculty.

SOMMER, ChristophRolfing SI in Its Relation to Osteopathy, Especially the Lineage of Visceral Manipulation Developed by JeanPierre Barral[:]